Postpartum psychosis

[ellymouse]

Hello, i was diagnosed with psychosis two years ago and depression when i was 15. I was referred to a specialist unit and started on respiradone to which i had no response. the only antipsychotic i found worked for me was seroquel but i took myself off it when i found out i was pregnant. i hadn't really done any research on seroquel up until that point, it worked thats all i needed to know. but when i found out i was pregnant i started trawling the internet (much to my psychs annoyance!) and was really disturbed by the stuff on seroquel plus the fact it knocks you out and i mean it knocks you out which is no good with a baby to get up for. so i tried no meds but that didnt work (but i was under a lot of stress at that time) and i got really sick again so they put me on sulpiride. its not as good as seroquel but it levels me out and gets rid of most of my symptoms.
my psych asked me if i wanted to breast feed and i said yes, he's recommended i dont and that they really up the dose postpartum as he says i'm really high risk to relapse. i was really shocked and said that i felt quite strongly that i wanted to bf and would come off meds if neccesary and he said if his wife was pregnant and had my history he would bottle feed and dramatically up the dose.
sulpiride is considered low risk by hale but my psych says he wont recommend it and now i feel really low as i've always wanted to bf my children. also i think he's worried i'll sue him if there are abnormalities.
so does anyone have any experience/ advice on postpartum psychosis, sulpiride, safe antipsychotics to bf on or relapse of psychosis? anything at all that anyone knows or just advice would be so helpful, feel i cant talk to psych cuz he's bein so black and white on this one.
sorry this is so long too!

Did your baby never suffer from colic then newtohere? Mine did even whilst being breastfed. It's not as simple as lifting up your top and going back to sleep. Breastfeeding hurt me with both of mine, for some women even though they are doing it right, it just hurts. I was in pain everytime I fed for the first 6 months.

I gave up feeding dd because of it after 4 months and I never regretted it.

Also they cry for things other than milk, they have a tendency to soil their nappies at 2am and 4am on the dot. They cry because they are bored, because they have colic, because they feel unwell. It's mentally and physically exhausting caring for a baby, entire days just blur and you don't know if it's lunchtime or suppertime or when the last time you ate was. All you can think about is sleep for those first few months.

Postpartum psychosis is NOT PND. Some women hallucinate, some hear voices (I did, although mine was whilst still pg), it can be a very scary time and you may not be able to care for yourself properly. Breastfeeding may work for you, but then again it may not, it is not a magical solution for staving off PND or any other kind of depression, if it was then believe me, the NCT and LLL would be announcing it from the rooftops.

We are advising the OP to look into it by all means, to question the psychiatrists advice (and I second that he won't know shit about breastfeeding) and to get a second opinion. But the OP has tried coming off the meds once and it didn't work. It would be dangerous to suggest she try again because breastfeeding will sort it all out.

Go easy ellymouse. Your baby needs your love and attention more than your milk. I was bottlefed too and am absolutely fine. My dh's nephew was exclusively breastfed by his organic vegetable eating mother and he has severe asthma. Bottle milk now is better than it was in the 70s, 80s or even 90s. Whilst it's no substitute, it's not evil either. And if it means that you get to enjoy your baby rather than going around in a constant state of anxiety then I would choose the bottle.

But if you can compromise, ask for a different type of med or a lower dosage or whatever then do so. Only you know how you would cope without your meds, so once you have all the info the choice is yours and yours alone.

No doubt that breastfeeding is quite likely to hurt at first, even on my second child it was a bit 'oww' at times over the first week.
You have a little human latching onto you with the strongest suction ever, bad positioning can make it excruciating and you can then get sores and not be able to heal if it isn't sorted quick. The worst thing is that nurses are often so pro-breastfeeding that they won't warn you at all and even say it doesn't hurt! lol
But it can be so worth it.
Ask the nurse every 5 minutes if you need to that you are attatching the baby properly, once you get the knack it normally wouldn't be uncomfortable for more than a week or so.
I'm not going to say breastfeeding is always easy and doesn't hurt, you have to be realistic, but once it's established (for me after a a few days i was fine) then it can be brilliant.
I'm sorry it never worked out for you to the last poster.

OP do what you feel is right.
Having engorged breats and mastitus from *not breastfeeding i imagine would be as much as a pain during the first week.

I had the NCT breastfeeding counsellor coming in including midwives to check my positioning, everything was fine but it hurt so much it made my toes curl.

There have been several threads on this very topic on Mumsnet over the years. It is now conceded that you can be doing everything right and it can still hurt. You just get used to it over time.

I thought it would be better with my second, I got used to it quicker but the pain was just as intense.

Mastitis is something you have to watch out for, but at least you know what that is and how to treat it (course of abs for me).

As another women who has suffered ante natal depression, I would agree whole heartedly with Rhubarb.

more damage will be done to the bond between you and your baby if you are sectioned under the mental health act, or otherwise cannot care for him, than by feeding him with a bottle.

I think for me the reason breastfeeding was so painful I was in tears with the first, is because; I didn't get the latch right from the start so the damage was already done and I needed to heal but your breasts don't get a break if youre constantly BF, also being more sensitive because of sleep deprivation and fear of knowing theyre about to hurt you.

Now with the second; I must have annoyed those nurses by asking them so often, but thats what theyre paid for, for the first 24 hours i wouldnt put my breast in his mouth unless the nurse was right there to okay i was doing it completely correctly.
You need to get the baby's mouth wide as possible and shove a whole lotta breast in there, lol, so they suck on the areola, not the nipple! nipple dangling is oww

It's a shame there's not a cream that will make your nipples completely numb for those difficult stages, that would be so helpful

colditits
OBVIOUSLY that would be the worst senario.

I was advising breastfeeding, because as i explained my mother (who was sectioned after each child with schizophrenia and psychosis amongst many labels given) SHE believes it all happened because after 2 normal weeks with the first she had to suddenly stop breastfeeding and then it all went down hill.

Having a breakdown is exactly what you want to avoid. We beleive that breastfeeding keeps you feeling in that loved up maternal state, when the baby leaves your body and you don't breastfeed your hormones will dramatically drop which could cause problems. BF acts as a way to keep you 'up'.
That's the theory anyway.

Bfing certainly didn't keep me 'up'!

Everyone is different and you are bound to get down after BFing because your hormones go down, naturally. But if bfing really was a cure all for depression we would know about it. What worked for your mother may not work for other people.

I received progesterone injections for a week after giving birth to prevent PND because they thought my depression was hormone related. I now know that the very same treatment can actually CAUSE depression in others. So I wouldn't recommend it, but it worked for me.

ellymouse - I suppose the upshot is that breastfeeding can do different things to different mothers. Just be aware of this and try and find out which category you fall into.

Just like pregnancy - the hormones make some people feel on top of the world and others extremely sick.

Anyway, if you feel that breastfeeding is causing you mental health problems, then you should definately formula feed with zero guilty feelings. Doing the best thing for your baby involves doing the best thing for yourself as well so that you can be there for your baby.

thank you all so much for your responses it's been lovely sitting here reading them all. i've been getting myself in such a state over this, it's been so helpful to get a range of opinions rather then just going back and forth in my head, i wish i'd posted sooner! in fact i've been sitting here with a notepad and pen to write down all the important bits so i can do more research or take it in with me to see my psych.
i'm going to ask my psych about haloperidal as an option, ring the breastfeeding support line and that article mentioned in breastfeeding matters sounds really helpful. i'll also ask about the care plan at my cpa next week, i think this will be important to get done now when i'm well as i guess nobody knows whats going to happen.
i think its probably best to be on meds post birth, on a low dose of the most bf friendly if possible and be prepared to stop and up the dose if neccesary. sometimes i lose perspective when i'm ill and wont want to do this so thats why i'm glad you mentioned the care plan so i can say in advance. i see my psych next week so i'll mention all the stuff you've told me.
if anyone does have any more suggestions or advice though then i'd still really appreciate it, i think the more i hear then more confident i'll feel when seeing my psych and making decisions.
thanks so much!

Let us know how you get on.

i will do, still quite nervous about meeting with psych, but at least now i've got a list so i don't get flustered and forget things then just back down.

Hi Ellymouse

I had depression antenatally and was on haloperidal for bipolar. I did not take antidepressants in pg but immediately post partum I suffered a huuge physical reaction to haliperidol and was very, very ill with bipolar / post partum psychosis and was admtted to a mother and baby unit (who were fab btw).

I am fine now and have had excellent support from our local perinatal unit, and if you have a perinatal team you can get referred to they are def the best people to talk to re antenatal med and post natal meds for bf. I have found that they are far more confident of using medications than your GP or any adult mental health specialists.

I am on seroquel and am bf dc of 8 mths. I have been told that this is fine to take and it has really made me feel stable. I have discussed ttc again in a year or so and been advised to stay on seroquel if it suits me for ttc, pregnancy and beyond.

Obviously I would prefer to be off all medications, but any medications are about weighing up all possible risks and benefits. There are some antipsychotics and moodstablisers that def should not be taken in pg etc but haloperidol and even seroquel are now seen as safe.

I found bf v hard psycholgically at first (I didn't want the closeness) but it did really help with bonding and confidence because it was one thing that I could do for my son that no-one else could. I did have a lot od support by the MH teams for this (as they knew of no-one else so poorly who continued) and they provided lactaction consultants to help. My ds was (and still is) a lazysod pain to bf as he has a very lazy latch and figures that if he actually has to suck to get the milk out it's not worth it (cue loads of swapping between boobs until he settles).

I did though do mixed feeds to begin with and did supplement with ff when very poorly, and when ds started almost completely rejecting the breast, very nearly went down to completely bottle feeding (until he suddenly rejected the bottle at 11 weeks)so I can appreciate that you can still feed with love from a bottle.

It was so hard to bf in the very early days with pnd psychosis that it was very difficult to continue and I took every day bf one at a time. Many people I know with pnd / depression felt that ff did help them as it removed some of the anxiety and pressure of bf.

After a few weeks, however it just got easier and a lot better, and now it is something that we both enjoy so I am sure that if it is enjoyable it benefits mental health.

Whatever route you go down though, just do whatever feels right for you in your circumstances and don't feel pressured. All the best x

sorry for the typos rocking son constantly!

rhubarb- i just wanted to point out that breastmilk is made from blood so it is very likely to be contaminated.

Elly, while you're doing your research, this is the guideline that NHS professionals should follow when treating you. Chapter 7 is all about which drugs can be taken whilst BF'ing, and supporting women to try to do so.

It's a bit dense I'm afraid, but very informative. Good luck with everything.

RunLyra that was a really helpful link.

Here is the bit from the guidelines about anti-psychotics:

Antipsychotics
1.4.3.4 Women taking antipsychotics who are planning a pregnancy should be told
that the raised prolactin levels associated with some antipsychotics (notably
amisulpride, risperidone and sulpiride) reduce the chances of conception. If
prolactin levels are raised, an alternative drug should be considered.
1.4.3.5 If a pregnant woman is taking clozapine, switching to another drug and
careful monitoring should be considered. Clozapine should not be
routinely prescribed for women who are pregnant (because there is a theoretical
risk of agranulocytosis in the fetus) or for women who are breastfeeding
(because it reaches high levels in breast milk and there is a risk of
agranulocytosis in the infant).
1.4.3.6 When deciding whether to prescribe olanzapine to a woman who is pregnant,
risk factors for gestational diabetes and weight gain, including family
history, existing weight and ethnicity, should be taken into account.
1.4.3.7 Depot antipsychotics should not be routinely prescribed to pregnant
women because there is relatively little information on their safety, and
their infants may show extrapyramidal symptoms several months after
administration of the depot. These are usually self-limiting.
1.4.3.8 Anticholinergic drugs should not be prescribed for the extrapyramidal side
effects of antipsychotic drugs except for acute short-term use. Instead, the
dose and timing of the antipsychotic drug should be adjusted, or the drug
changed.

sorry I posted the bit relating to pregnancy, here is the bit relating to breast feeding:

7.2.4 Antipsychotics
There is some indication of an overall increased risk of malformations associated with
the use of antipsychotics (2.4%, that is 24 per 1,000), although it is not clear if this
may relate to the underlying illness (information on individual drugs is very limited
[Altshuler et al., 1996; Slone et al., 1977]). However, a prospective matched-case
control study (151 women exposed) found no evidence of increased risk for exposed
mothers compared with non-exposed mothers (McKenna et al., 2005), although, again,
Pharmacological treatment of mental disorders in pregnant and breastfeeding women
206
data on individual drugs are limited. There is little evidence to distinguish between
any first- or second-generation antipsychotic, although there is some evidence that
olanzapine is associated with greater and significant adverse effects on weight, lipids
and glucose metabolism compared with other antipsychotics (Nasrallah, 2006), leading
to a concern about increasing the risk of the development of diabetes, and some
uncertainty whether the accumulation of clozapine in the fetus may increase the likelihood
of floppy baby syndrome and neonatal seizures. Olanzapine appears to be
associated with the onset of diabetes in patients with schizophrenia compared with
both patients with schizophrenia who did not take any antipsychotic and with those
taking conventional antipsychotics (Koro et al., 2002). In a further study of patients
with schizophrenia, atypical antipsychotics were associated with the onset of
diabetes, in particular clozapine, olanzapine and quetiapine (Sernyak et al., 2002).
Some antipsychotics (such as amisulpride, risperidone and sulpiride) are known
to raise levels of prolactin and this can make it difficult for women to conceive. With
regard to taking clozapine during pregnancy, there is a theoretical risk of agranulocytosis
in the fetus, and also a risk of agranulocytosis in breastfed infants (Eberhard-
Gran et al., 2006). There are very few data on the safety of depot antipsychotics in
pregnancy and, generally, these preparations should be avoided because of their lack
of flexibility. Although symptoms are usually self-limiting, infants may show
extrapyramidal symptoms several months after administration of the depot.
There is concern about the accumulation of antipsychotics in breast milk and the
potential impact on children (Briggs et al., 2002). A review of the published literature
on atypical antipsychotics found no data on levels of the drugs in breast milk in mothers
taking quetiapine, ziprasidone or aripiprazole (Gentile, 2004). It also found that,
while levels of risperidone in breast milk are low, those of clozapine are relatively
high and that this drug has also been subject to reports of adverse reactions in infants,
including sedation, agranulocytosis and cardiovascular instability. Olanzapine is
detectable in breast milk and adverse reactions have been reported, but it is unclear
whether these were related to olanzapine (ibid.).

I would still question which was best for a baby, contaminated breastmilk or formula.
breastmilk is so superior to formula that like i said they would have to be pretty awful meds to make breastfeeding the less desirable option.
Here is a good article on the differences between formula and natural feeding.
Obviously it's a matter of weighing up health risks, you staying sane being absolutely paramount.

www.newscientist.com/article/mg19926641.700-making-formula-milk-more-like-mum s.html?full=true